1
Breaking Down the Silos
Session # INT1 February 11, 2019
Elise Anthony, Esq., ONC
Steven Posnack, M.S., M.H.S, ONC
Terrence O’Malley, M.D., Partners HealthCare
2
Elise Anthony, Esq.
Steven Posnack, M.S., M.H.S.
Terrence O’Malley, MD
Have no real or apparent conflicts of interest to report.
Conflict of Interest
3
Overview: connecting the dots. Policy, Payment, Technology
The Building Blocks of Interoperability
Business Case
Governance
Vocabularies
Transport
Repository of best available standards
What’s new and what’s coming
Agenda
4
Understand the importance of a compelling business case
Know what this all means
TEFCA
DIRECT
FHIR
USCDI
DEL
ISA
Learn the latest advances in
Content
Transport
Governance
Operational Standards
Learning Objectives
5
Tectonic Shift in Payment
5
Fee for Service
-Payment for each unit of
service. Produce
as many units as possible.
-No limit to number of units.
Revenue is variable.
-Time is money.
-Coordination and communication
are not priorities.
-Interoperability adds little value.
Value Based Payment
-Payment for each member of a
population unaffected by services
provided. Reduce total costs
-Revenue is fixed, savings are
variable.
-Time is savings.
-Coordination and
communication
are essential.
-Interoperability
improves
care.
6
Pick That Triangle!
6
Hospitals
Ambulatory
Care
Skilled
Nursing
Facilities
Home
Health Care
Community
Based
Services
Revenue
Cost of services
Time with patient
HIT Resources
Hospital
avoidance
Standardized
vocabulary
HIPAA
7
Pick a Dot, Any Dot
INTEROPERABILITY
Payment
Reform
HITECH
ACA
MACRA
ISA
TEFCA
USCDI
DEL
FHIR
21
st
Century
Cures
Act
IMPACT
Act
C-CDA
Workflow
8
Elise Sweeney Anthony, JD
Executive Director, Office of Policy, ONC
Elise.Anthony@HHS.gov
Steven Posnack, M.S., M.H.S.
Executive Director, Office of Technology, ONC
Steven.Posnack@HHS.gov
Terrence A. O’Malley, MD
Physician, Massachusetts General Hospital,
Partners HealthCare
Tomalley@MGH.Harvard.edu
Please complete the online session evaluation. Thank you.
Contact Information
9
Appendix
10
Spending is Unequally Distributed
11
Who are the Top and Pre-Top 5%?
Individuals with complex medical, behavioral, functional and environmental
issues including adverse social determinants
High utilization of emergency responders, emergency departments, hospitals,
nursing facilities, home nursing and home based services
Care from multiple providers
Care in multiple sites
Multiple care transitions
Need a longitudinal shared-care plan
April 10, 201811